Psoriasis

Psoriasis is a multifactorial chronic inflammatory disease that affects the skin and nails, and is often accompanied by pathology of the musculoskeletal system.

If you're concerned about red, dry patches of various shapes and sizes on scaly, itchy skin, make an appointment with a dermatologist.

Our doctors treat psoriasis using an integrated approach - using both medical treatment methods (ointments, gels, aerosols, tablets and drug injections) and proven treatment with excimer light using Italian laser devices.

Causes of psoriasis

Doctors name several reasons for the development of psoriasis:

• Genetic predisposition - scientists have described several genes, the presence of which predisposes to the onset of the disease;
• Malfunction of the endocrine, immune and nervous systems;
• Negative effects of certain environmental factors.

There are also provoking factors, including:

• Chronic infectious diseases (most often caused by streptococci);
• Alcohol abuse, chronic alcoholism;
• Weather conditions (dry or cold climate);
• Skin trauma (scratches, insect bites, sunburn);
• frequent emotional stress;
• Taking certain medications (for example, lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
• Abrupt withdrawal of systemic hormonal drugs.

You should not believe the myth that dry skin and excessive hygiene can cause psoriasis - this is absolutely not true!

Stages of psoriasis

Currently, doctors distinguish 3 stages of the disease:

• Progressive - it is characterized by an increase in the number of rash elements, a combination of papules, and the appearance of new elements in the injured area. The plaque is bright pink and covered with scales. The rate of cell division in the new lesion increases 10-fold;
• Stationary - no fresh elements observed, stagnant red plaques, almost no exfoliation, itching almost does not bother;
• Regressive - weakens the intensity of the color of the rash, the elements of the rash are pale, the new ones do not appear, there is no peeling, no subjective signs are observed. A white pseudoatrophic rim forms around the plaque, and healthy skin appears in the center of the large plaque. A colorless spot remains at the site of the rash.

In some cases, patients have elements on their skin at different stages of development at the same time.

Disease symptoms

Dermatovenerologists first of all pay attention to the presence of the psoriatic triad. This is accurate bleeding, terminal film symptoms and stearin effects.

"Stearin spot" appears when you scratch the plaque - you can see increased exfoliation, and the surface of the papule becomes similar to crushed drops of stearin.

The so-called terminal film can be seen if the scales are completely removed - a wet, thin, shiny film will appear on the surface.

Spot bleeding (Auspitz's symptom) - exposed on the skin when the scale is removed.

Dermatologists also highlight the Koebner phenomenon - the appearance of a psoriatic rash at the site of skin trauma (scratches, injuries).

The symptoms of psoriasis depend on the type, but there are some common ones:

• Rashes - they are always present in one form or another;
• Tightness of the skin in the location of psoriatic elements;
• Itching of varying intensity.

Plaques in psoriasis appear in various places, but there are also areas with normal localization:

• Scalp (with this arrangement of plaques we are talking about seborrheic psoriasis);
• Knees and elbows;
• Skin folds and flexor surfaces - elbows, knee joints, groin, armpit area, under the breast (this localization allows us to talk about inverse psoriasis);
• Lumbar, sacrum;
• Palms and feet - respectively, with palmoplantar psoriasis;
• Nail psoriasis – pitting of the nail plate, subungual bleeding, separation of the nail from the base of the nail (onycholysis).

In addition to skin manifestations, psoriasis also causes other symptoms. For example, in the arthropathic form it will be pain in the joints, their swelling (most often this manifestation is localized in the legs, hands, ankles and knee joints).

Types of psoriasis

Dermatologists distinguish several types of diseases:

Abusive(plaque, common) is the most common and accounts for 90% of all cases of psoriasis. With this type of disease, flat inflammatory elements (papules) of red-pink color stand out on the surface of the skin and have a clear border.

They tend to merge, and plaques of different sizes are formed, covered with silvery scales. In appearance it resembles a wreath or a geographical map.

Psoriatic elements are found mainly on the scalp, on the extensor surfaces of the elbows and knees, on the skin of the lower back and sacrum, but they can also be found elsewhere.

Elbow psoriasis is treated as a special case (there is a permanent plaque on the elbow, and when it is injured, it starts to get worse).

Exudative– occurs more often in patients with endocrine diseases (obesity, diabetes, etc. ). In the lesion there is exudation, as well as a yellowish-gray crust.

in the form of teardrops– as the name suggests, many papules in the form of bright red drops are observed on the skin, peeling and infiltration are small. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into regular psoriasis.

Seborrheicdiffer in their localization - elements are found behind the ears and nasolabial folds, on the chest, in the interscapular area, on the scalp. The color of the scales is yellowish, sometimes they spread to the skin of the forehead and a "psoriatic crown" is formed.

Pustular– manifests itself as a limited (on the palms and soles) or widespread rash, represented by superficial pustules.

Among the pustular types, Barber's palmoplantar psoriasis is also distinguished, where pustules cover the soles of the feet and palms. It is characterized by severe itching, a combination of pustules with the formation of crusts. This disease also often affects the nails.

Pustules are also present in generalized Tsumbusch psoriasis. This type of disease is characterized by bright erythema (redness) and the appearance of superficial pustules. There is a burning sensation and pain in the area of the rash. Lesions grow quickly, coalesce and cover larger areas of skin. With Tsumbusha psoriasis, detachment of the epidermis (top layer of the skin) occurs and the so-called "purulent lake" is formed. Patients experience general lethargy, they are tormented by fever, burning and tingling in the affected area.

Psoriatic erythroderma

Doctors focus specifically on this type of psoriasis, psoriatic erythroderma. In this case, the pathological inflammatory process involves all or almost all of the skin. It becomes rough, tight, covered with peeling elements, and the skin becomes red.

Many of our patients complain of fever rising to subfebrile levels and feeling unwell. There is an increase in peripheral lymph nodes. Erythroderma can develop as a result of improper treatment of psoriasis (bathing, too intense tanning, high concentration of medicated ointments, etc. ). In other cases, this process develops in healthy people if psoriasis has just started and develops quickly.

If psoriatic erythroderma exists for a long time, the patient may experience nail damage and hair loss.

Psoriatic arthritis

This pathology is also called arthropathic psoriasis. Joint damage can develop in parallel with the rash, and in some cases starts earlier and is a sign of psoriasis.

Mainly the small joints of the feet and hands are affected, but sometimes the wrist and ankle joints are also involved in the inflammatory process. Patients are concerned about joint pain, swelling, deformity and limited mobility.

Diagnostics

The main task of diagnosis is to determine the percentage of skin lesions throughout the body. This is necessary to evaluate the effectiveness of treatment in certain patients.

There is an opinion that to make a diagnosis you need to undergo a large number of tests. But in most cases this does not happen, and a thorough examination of the rash by a dermatovenerologist is sufficient. Psoriasis has characteristic manifestations, so visual diagnosis is not difficult.

In typical cases, this is the psoriatic triad: pinpoint bleeding, terminal film symptoms and stearin effects. Often, patients are bothered by itching that varies in intensity. The presence of psoriasis in relatives is also important.

However, there are skin symptoms that should be distinguished when diagnosing the disease. For example, with papular syphilis, the same picture is observed. In this case, the doctor will carry out a differential diagnosis, including a serological study.

Scalp psoriasis is sometimes confused with seborrheic dermatitis. With psoriasis, the doctor determines that there are papules on the skin - that is, compactions that rise above the skin level and are covered with scales.

In the form of arthropathic psoriasis (when there is no skin rash), the dermatologist needs to make sure that it is psoriasis and not rheumatoid polyarthritis.

Often psoriasis occurs together with other diseases, then doctors talk about comorbid diseases. For example, psoriasis can be combined with coronary heart disease, diabetes, depression, or gastrointestinal pathology.

If a dermatologist diagnoses psoriasis, he will definitely refer the patient to consult a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And this specialist will prescribe an extensive examination (for each disease there is a list of standard tests, in particular blood tests).

The diagnostic base of the modern clinic is represented by the most modern devices and devices. This will allow you to undergo a comprehensive examination for various diseases.

Laboratory studies are carried out using modern biochemical and hematological analyzers. An ultrasound diagnostic doctor examines the patient using a state-of-the-art ultrasound machine.

In the radiology department, equipped with the latest medical technology, you can undergo radiography and mammography. In the clinic you can also do an MRI or CT scan of any organ.

Doctors of the functional diagnostic department have the opportunity to conduct all necessary studies: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, determining external respiratory function and other important indicators.

The widest range of diagnostic tests presented in our clinic allows doctors to identify diseases at almost any stage of development.

Treatment

The main goal of treatment is to control the disease and put it into remission (weakening or disappearance of symptoms). In the treatment of psoriasis, doctors use several instructions at once: medicine (ointment and other dosage forms for external use, as well as tablets for systemic therapy) and phototherapy using excimer light.

External medications include creams, ointments, gels, emulsions, and sprays that contain hormonal medications. Glucocorticosteroids suppress the immune system and relieve inflammation. They are presented in various dosage forms in each specific case, the doctor will choose an individual treatment regimen for you.

To reduce itching and dry skin, moisturizers and emollients are used.

To relieve the manifestations of psoriasis on the scalp, the use of special shampoos is prescribed.

Calcipotriol (a vitamin D analog) is also prescribed for local treatment.

In systemic therapy, doctors prescribe immunosuppressive drugs. These medications are often given in small doses (once a week) to treat the common, hard-to-treat type of psoriasis. The same regimen is used in patients with rheumatoid arthritis. Administration is oral, intravenous, intramuscular or subcutaneous.

Doctors also prescribe retinoids (drugs with biological properties similar to vitamin A).

Systemic glucocorticosteroids are used very rarely and only in very difficult cases.

When the process decreases, the frequency of use of external agents and oral drugs changes towards a decrease.

Note that some drugs have a negative effect on fetal development (for example, selective immunosuppressants), so they are contraindicated in pregnant women.

No alternative treatment leads to positive results. You should not experiment and trust your health to traditional medicine practitioners and methods with unproven effectiveness.

Our doctor urges you not to self-medicate and not to stop (prescribe) yourself various medications, because this can only worsen the situation and cause an increase in rashes!

Psoriasis treatment using laser devices 

The Dermatovenereology Center offers you an effective method of treating diseases using the excimer laser system. This is the main physiotherapeutic treatment for psoriasis and some other skin diseases with proven effectiveness.

Excimer lamps operate on xenon-chlorine compounds and emit light in the UV range. Only rays of a certain length penetrate the skin and reduce inflammation in the skin. Plaque thickness decreases.

Radiation only affects "sick" cells without affecting healthy skin. This therapy reduces the population of T lymphocytes in areas of the skin covered with plaque. In this way, a stable remission is achieved, and in many cases, treatment with excimer light makes it possible to abandon hormonal drugs.

This method allows you to forget the torment that seasonal exacerbations bring to psoriasis patients.

Dermatovenerologists first identified indications and contraindications for phototherapy treatment with monochromatic excimer light.

Indications include:

• Psoriasis;
• Vitiligo;
• Atopic dermatitis;
• Patchy baldness (alopecia);
• Discoloration of scars;
• Eczema.

There are few contraindications for the procedure, these include:

• Pregnancy;
• oncological diseases;
• Bad general condition.

Why you should pay attention to system treatment 

Dermatovenereologists note several undeniable advantages of treatment with excimer light:

• The effect is local, only on psoriatic plaques, the radiation does not affect the whole body;
• In mild cases, it is enough to prescribe only phototherapy and photosensitizers to achieve stable remission;
• Prescribed to patients of any age (starting from 3 years);
• Treatment with the laser system does not require a hospital stay, it easily fits into any work schedule;
• Effective for various forms of psoriasis;
• Minimum restrictions.

How is the treatment procedure carried out?

At your first appointment, the doctor will conduct a test for you, during which he will determine the phototype of your skin and determine the minimum dose of ultraviolet radiation.

The next day you come for an appointment, where the doctor determines the most appropriate test results. That is, the doctor will choose the radiation power individually, which is suitable specifically for your skin.

There are no restrictions during treatment; you will only be advised to limit spicy and fatty foods and drink plenty of fluids.

The effect of phototherapy occurs after only a few procedures, and for a stable remission you need about 5-10 procedures (in some cases 15).

The duration of one procedure is from 10-20 minutes, it depends on the treatment area and the number of affected areas.

Psychological help

We always encourage you to remember that psoriasis is not contagious! However, patients are often not worried about the discomfort of the presence of a rash but about the reactions of others. This is especially painful for women and children.

Children may behave cruelly towards sick children. Therefore, it is very important to prescribe timely treatment, including consultation with a psychologist or psychotherapist.

Benefits of treating psoriasis in the clinic

Patients choose to treat psoriasis for several reasons:

• Experienced and qualified dermatologists and cosmetologists;
• Elimination of both dermatological and cosmetic problems at the same time;
• Innovative treatment methods, especially using laser systems;
• The most modern diagnostic methods;
• Opportunity to consult with doctors of various specialties.

If you are concerned about plaque, itching and peeling skin, contact the clinic. You can always seek qualified medical care.

Prevention of psoriasis

The main task of the dermatovenerologist is to prevent the exacerbation of psoriasis. To this end, they set preventive measures:

• Stress prevention;
• Cold prevention;
• Control over the focus of chronic infection;
• Refusal to wear rough and tight clothes that hurt the skin.

Thanks to preventive measures and timely treatment of psoriasis, doctors can quickly reduce the severity of the disease and achieve the disappearance of many symptoms of the disease.

What happens if the disease is not treated?

If left untreated, the rash will spread and cover more skin. A transition to the erythrodermic type is possible, which is much more difficult to treat.